Diabetic Ketoacidosis

What Is It?

Diabetic ketoacidosis is a potentially fatal complication of diabetes that occurs when blood glucose levels are high (often above 400 milligrams per deciliter) and insulin levels are very low.

Insulin helps glucose to pass from the bloodstream into body cells, where it is burned as an energy source, and it prevents excessive release of stored glucose by the liver. It normally is produced by the pancreas, but people with type 1 diabetes (insulin-dependent diabetes) don't produce an adequate quantity of insulin and must inject it daily to control their blood glucose. When insulin levels are too low, glucose levels in the blood rise and body cells go hungry. Without access to glucose, body cells are forced to burn fat for energy. This produces acidic chemicals called ketone bodies that are toxic at high concentrations.

In diabetic ketoacidosis, various ketone body types (acetone, acetoacetate, hydroxybutyric acid) accumulate in the blood, seriously altering the normal chemistry of the blood and interfering with the function of multiple organs. The blood becomes abnormally acidic, which causes vomiting and abdominal pain. If the blood becomes more acidic, ketoacidosis can cause falling blood pressure, coma and death.

Ketoacidosis is always accompanied by dehydration, which is caused by high levels of blood glucose. When blood sugar levels are very high, some sugar "overflows" into the urine. When sugar is carried away in the urine, water, salt and potassium are drawn into the urine with each sugar molecule, and your body loses large quantities of fluid because the volume of urine produced is much larger than normal. Usually, you can't drink enough fluids to keep up with the pace of urine production. You urinate frequently, despite increasing dehydration. As water is lost from the body, the blood (including the glucose that it contains) becomes more concentrated. Vomiting caused by the blood's acidity also contributes to fluid losses and dehydration.

Diabetic ketoacidosis can occur because a diabetic has stopped taking normal insulin injections or is not taking enough insulin. It also can be triggered by an infection or severe physical stress, such as an injury or surgery. People with type 1 diabetes are at risk of diabetic ketoacidosis. It rarely occurs in people with type 2 diabetes. In about 25 percent of children with diabetes, symptoms from ketoacidosis are the first sign that they have diabetes.

Symptoms

Symptoms of diabetic ketoacidosis include:

• More frequent urination
• Extreme thirst
• Dry mouth
• Cool skin
• Nausea and vomiting with or without abdominal pain

As blood ketone levels increase, the person's breathing pattern may become slow and deep, and his or her breath can have a fruity odor. A person with ketoacidosis may seem to be tired or confused or may have trouble paying attention. Without prompt treatment in the first day of symptoms, the illness may cause low blood pressure, a loss of consciousness, coma or death.